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Difficulty: HardAccident, Error, and Injury Prevention

After receiving the morning handoff report, a nurse reviews the prescribed therapies and planned interventions for four clients. Which planned intervention poses the highest risk for severe client injury and must be questioned immediately?

  1. Administering a scheduled dose of intravenous ceftriaxone as a secondary piggyback through a continuous infusion of Lactated Ringer's solution.Answer
  2. B
    Assigning an unlicensed assistive personnel (UAP) to feed a client who had a stroke three days ago and has successfully passed a speech-language pathologist's swallow evaluation.
  3. C
    Initiating a trial of a concealment sleeve and a bed alarm for an agitated client with delirium before requesting a prescription for physical restraints.
  4. D
    Assisting a client who underwent a lumbar puncture one hour ago to maintain a strictly flat, supine position in bed without a head pillow.

Answer

The planned intervention of administering intravenous ceftriaxone through a continuous infusion of Lactated Ringer's solution poses the highest risk and must be questioned.
Administering intravenous ceftriaxone alongside Lactated Ringer's is strictly contraindicated. Lactated Ringer's is a calcium-containing solution, and calcium binds with ceftriaxone to form a precipitate. This precipitate can lodge in the microvasculature of the lungs and kidneys, leading to life-threatening emboli and organ failure. Preventing this specific medication error is a critical safety priority.

Step-by-Step Solution

1
Analyze each planned intervention for potential safety hazards, adverse effects, or protocol violations.
Identified that three interventions are standard safe practices, while one presents a critical physiological risk.
Prioritization requires identifying the action that poses an immediate threat to the client's life or limb.
2
Evaluate the intravenous compatibility of ceftriaxone and Lactated Ringer's solution.
Lactated Ringer's contains calcium, which is strictly incompatible with ceftriaxone.
Understanding pharmacological contraindications is a core component of accident and error prevention.
3
Determine the clinical consequence of this incompatibility.
Mixing these solutions creates calcium-ceftriaxone crystals (precipitate) that can lodge in the lungs and kidneys, causing fatal organ failure.
This establishes the intervention as the highest priority error requiring immediate prevention.

Key Concept

Preventing adverse clinical events requires verifying intravenous medication compatibility, specifically avoiding the potentially fatal combination of ceftriaxone and calcium-containing solutions like Lactated Ringer's.
Estimated Time:1m 30s
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Topics

Accident, Error, and Injury Prevention

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